Re-location of main body bypass branch on multi-branched stent graft

ABSTRACT

Methods, systems, devices and apparatuses to support the walls of one or more blood vessels and perfuse blood through the one or more blood vessels. The stent device allows perfusion through one or more vessels. The stent device includes a tubular member. The tubular member has a single body that includes a main body lumen, a bypass lumen and one or more branch lumens. The tubular member is configured to be inserted into the aorta. The main body lumen is configured to expand and support a vessel wall of the aorta and the one or more branch lumens are configured to connect to one or more extension grafts that extend within one or more branch vessels. The stent device includes multiple rings of stents. The multiple rings of stents are positioned within the tubular member and are configured to be expandable to expand the tubular member to support the tubular member against the vessel walls.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of and claims the benefit of U.S.patent application Ser. No. 16/446,403, filed Jun. 19, 2019, now allowedwhich claims priority to and the benefit of U.S. Provisional PatentApplication No. 62/686,879 titled “RE-LOCATION OF MAIN BODY BYPASSBRANCH ON MULTI-BRANCHED STENT GRAFT,” filed on Jun. 19, 2018, and theentirety of which are hereby incorporated by reference herein.

BACKGROUND 1. Field

This specification relates to a system, a device, a method and/or anapparatus for a stent device with multiple branches or bypass lumens.

2. Description of the Related Art

Aneurysms occur in blood vessels in various locations due to age,disease, or genetic disposition, and insufficient blood vessel strengthor resiliency may cause blood vessel walls to weaken and lose shape asthe blood flows through the weakened blood vessels. Left untreated,these weakened blood vessels may continue to expand to the point wherethe blood vessel wall cannot hold, and the blood vessel may fail at theweakened locations, which may result in fatal consequences.

Many implantable medical devices are used and advantageously inserted toprevent rupture of an aneurysm. For example, a stent graft may beintroduced, deployed and secured in a location with the blood vesselsuch that the stent graft spans the weakened areas of the blood vessel.The outer wall of the stent graft may abut and seal against the interiorwall of the blood vessel to assist in channeling the blood flow toreduce any stress to the walls of the blood vessel at the weakenedlocation.

Aneurysms may occur in a variety of locations within the aorta, some ofwhich may not be treatable by conventional stent grafts. For example,conventional stent grafts may block branch arteries, which may result ininadequate blood flow to the associated parts of the body. Accordingly,there is a need for a system, a device, a method and/or an apparatus fora stent device with multiple branch or bypass lumens.

SUMMARY

In general, one aspect of the subject matter described in thisspecification is embodied in a device, a system and/or an apparatus tosupport the walls of one or more blood vessels. The stent device allowsperfusion through one or more vessels. The stent device includes atubular member. The tubular member has a single unitary body thatincludes a main body lumen, a bypass lumen and one or more branchlumens. The tubular member is configured to be inserted into the aorta.The main body lumen is configured to expand and support a vessel wall ofthe aorta and the one or more branch lumens are configured to connect toone or more extension grafts that expand within one or more branchvessels. The stent device includes multiple rings of stents. Themultiple rings of stents are positioned within the tubular member andare configured to be expandable to expand the tubular member to supportthe tubular member against the vessel walls.

These and other embodiments may optionally include one or more of thefollowing features. The one or more vessels may include the aorta, aceliac artery, superior mesenteric artery (SMA), a right renal arteryand/or a left renal artery. The tubular member may be configured toallow perfusion through the one or more vessels. The main body lumen mayhave an inner wall and the bypass lumen may be located proximally to theinner wall of the main body lumen. The bypass lumen may be connected tothe inner wall of the main body lumen to avoid obstruction of the one ormore branch lumens. The bypass lumen may be connected at a position thatoffsets from a top of the main body lumen. The bypass lumen mayterminate at or near a point of separation between the one or morebranch lumens and the bypass lumen.

The stent device may have a total coverage length, from a proximalaortic seal to a celiac artery of less than 8 cm, such as 5 to 8 cm or 5to 6 cm. The single unitary body may allow the tubular member to bearranged to minimize coverage of vessels. The tubular member may be madefrom a woven polyester and each ring of the multiple rings of stents maybe made from nitinol. The main body lumen, the bypass lumen and/or theone or more branch lumens may be connected but do not require overlap,connectors or fasteners to connect to form the single unitary body ofthe tubular member. The single unitary body may reduce the amount ofcoverage length of the tubular member and may reduce the number offailure points in comparison to a modular tubular member.

In another aspect, the subject matter is embodied in a stent device forperfusion of one or more vessels. The stent device includes a tubularmember. The tubular member has a main body lumen, a bypass lumen and oneor more branch lumens. The tubular member is configured to be insertedinto an aorta. The main body lumen is configured to expand and support avessel wall of the aorta. The bypass lumen is located and positionedwithin the main body lumen at a position that is offset from a top ofthe main body lumen. The stent device includes multiple rings of stents.The multiple rings of stents are positioned within the tubular member.The multiple rings of stents are configured to expand the tubular memberto support the tubular member against the vessel walls.

In another aspect, the subject matter is embodied in a stent device. Thestent device has a tubular member and multiple rings of stents. Thetubular member has a single unitary body including a main body lumen, abypass lumen and one or more branch lumens. The tubular member isconfigured to be inserted into an aorta. The main body lumen isconfigured to expand and support a vessel wall of the aorta. The bypasslumen is located and positioned within the main body lumen at a positionthat is offset from a top of the main body lumen. The stent deviceincludes multiple rings of stents positioned within the tubular member.The stent device is configured to be expandable to expand the tubularmember to support the tubular member against the vessel walls.

BRIEF DESCRIPTION OF THE DRAWINGS

Other systems, methods, features, and advantages of the presentinvention will be or will become apparent to one of ordinary skill inthe art upon examination of the following figures and detaileddescription. It is intended that all such additional systems, methods,features, and advantages be included within this description, be withinthe scope of the present invention, and be protected by the accompanyingclaims. Component parts shown in the drawings are not necessarily toscale and may be exaggerated to better illustrate the important featuresof the present invention. In the drawings, like reference numeralsdesignate like parts throughout the different views.

FIG. 1A shows an example unibody stent graft according to an aspect ofthe invention.

FIG. 1B shows an example side-perspective view of the unibody stentgraft of FIG. 1A according to an aspect of the invention.

FIG. 2A shows an example of the unibody stent graft of FIG. 1 that hasthe bypass lumen re-located within and integrally formed with the mainbody lumen according to an aspect of the invention.

FIG. 2B shows an example of the unibody stent graft of FIG. 1 that hasthe bypass lumen re-located within and fastened to the main body lumenaccording to an aspect of the invention.

FIG. 3A shows an example interior view of the bypass lumen disposedwithin the main body lumen of the unibody stent graft of FIG. 1according to an aspect of the invention.

FIG. 3B shows a top-down perspective view of the unibody stent graft ofFIG. 1 according to an aspect of the invention.

FIG. 3C shows another top-down perspective view of the unibody stentgraft of FIG. 1 according to an aspect of the invention.

FIG. 3D shows an example interface between the bypass lumen and the mainbody lumen of the unibody stent graft of FIG. 1 that uses a singlestitch along the entire interface according to an aspect of theinvention.

FIG. 3E shows another example interface between the bypass lumen and themain body lumen of the unibody stent graft of FIG. 1 that uses multiplestitches along the entire interface according to an aspect of theinvention.

FIG. 4 shows an example view of multiple extension grafts connectingand/or interfacing with the unibody stent graft of FIG. 1 that has there-located bypass lumen according to an aspect of the invention.

FIG. 5 shows a cross-sectional view of the unibody stent graft of FIG. 1positioned within the aorta to address aortic aneurysms and allowperfusion of blood according to an aspect of the invention.

DETAILED DESCRIPTION

Disclosed herein are systems, devices, methods and/or apparatuses for astent device. The stent device may be formed as a single unitary bodythat has a main body lumen, a bypass lumen and one or more branchlumens. The stent device may be inserted into the aorta and the one ormore branch lumens may be connected to or otherwise coupled with one ormore extension grafts that are inserted into one or more branch vesselssuch as the celiac artery, the superior mesenteric artery, the rightrenal artery and/or the left renal artery. As a single unitary body, themain body lumen, the bypass lumen and the one or more branch lumens areintegrally formed as a single piece that is deployed in an alreadycomplete state. This may be in contrast to modular device deploymentswhere a first device is deployed in the patient and then a secondarydevice is deployed in the patient that couples or connects to the firstdevice (e.g., like the extension grafts discussed, below). The termsunitary body and integrally formed may include that the various portionsare permanently connected together, such as by stitching. This reducesthe amount of coverage length of the stent device and the number offailure points in comparison to a stent device that is modular.

Other benefits and advantages include re-locating the bypass lumeninside into the main body lumen. By having the bypass lumen locatedwithin the main body lumen, instead of extending outward away from themain body lumen, the bypass lumen does not obstruct the one or morebranch lumens. This allows for a better and easier view of the differentlumens within the stent device when viewed under fluoroscopy becausethere are less lumens that may overlap one another. Moreover, thisallows for an extension graft to be connected to the bypass lumenwithout obstructing the one or more branch lumens. Additionally, thebypass lumen may be positioned within the main body lumen and offsetfrom the top of the main body lumen. This allows for another stent graftto be connected to or coupled with the top of the main body lumen, forexample.

FIG. 1 shows a stent graft 100. The stent graft 100 may have a tubularmember 101 and multiple rings of stents 126. The tubular member 101includes a main body lumen 102, a bypass lumen 104 and one or morebranch lumens 106. The multiple rings of stents 126 may be positioned onthe outside of the tubular member 101, on the inside of the tubularmember 101, or within the tubular member 101, such as in between layers,and may be self-expanding or balloon expanding. The stents 126 may beattached to the tubular member by stitching. The multiple rings ofstents 126 support the tubular member 101 against the vessel walls ofthe one or more blood vessels. When the stent graft 100 is deployed,each ring of stents 126 of the multiple rings of stents 126 may expandalong a circumference of the stent graft 100 to position the tubularmember 101 against the vessel walls of the one or more blood vessels toprovide support to the vessel walls and allow blood to perfuse throughthe one or more blood vessels.

The stent graft 100 allows blood to perfuse through one or more bloodvessels and supports the wall of the one or more blood vessels. Thestent graft 100 may be substantially cylindrical to maintain a completeseal with the wall of the one or more blood vessels. A stent graft 100refers to a prosthesis that includes a stent and a graft material thatforms one or more lumens within a blood vessel, such as the tubularmember 101. The stent may be a made of any suitable material, such as anitinol, stainless steel, nickel and/or titanium, and/or a biocompatible plastic. The stent may be composed of multiple rings and maybe of any shape, such as a sinusoidal, zig-zag or v-shaped ring. Thegraft may be made from a graft material, such as a biocompatible fabric,a woven polyester, fluorinated polymer include polytetrafluoroethylene(PTFE) and expanded polytetrafluoroethylene (ePTFE) or otherbiocompatible fabric. The graft may be shaped into the tubular member101.

The tubular member 101 may be a single unitary body formed from variousportions that when shaped by the stents form the different lumens. Thevarious portions are in fluid communication with each other and formedtogether to form the single unitary body. Since the graft has a unitarybody, there are less failure points where the different portions of thegraft may become disjointed, disconnected or otherwise fail to support aweakened portion of one or more blood vessels in comparison to a modularstent graft that has a modular tubular member with multiple portionsfastened or otherwise connected together in the patient. The stent maybe sandwiched in between the layers of the graft and/or may beinterwoven with the graft to form the stent graft 100 and shaped to formthe tubular member 101 with the different lumens.

The main body lumen 102 has a proximal end 112 and a distal end 114. Theproximal end refers to a portion that is positioned closest to theheart, and the distal end refers to a portion that positioned away fromand farthest from the heart. The main body lumen 102 may extend alongitudinal length of approximately 40-80 mm and may be positionedwithin the descending aorta 504, which is distal of the aortic arch, tosupport the inner surface of the vessel walls of the descending aorta,as shown in FIG. 5 for example. In one embodiment, the main body lumen102 may have a length of 45 to 75 mm, 50 to 70 mm, or 55 to 65 mm. Thetotal coverage length, from a proximal aortic seal to the celiac artery510, may be less than 8 cm, such as 5 to 8 cm or 5 to 6 cm, and may bearranged to minimize coverage of other vessels.

The main body lumen 102 defines a tubular wall 116 that may becontinuous with the bypass lumen 104, and the one or more branch lumens106 such that any fluid entering the main body lumen 102 must exitthrough one of the bypass lumen 104 or the one or more branch lumens106. That is, the main body lumen 102 is in fluid communication with thebypass lumen 104 and the one or more branch lumens 106.

The bypass lumen 104 and the one or more branch lumens 106 are in fluidcommunication with the main body lumen 102. The bypass lumen 104 and theone or more branch lumens 106 may each have a proximal end 118, 122,respectively, that is connected to, coupled to or integrally formed withthe distal end 114 of the main body lumen 102. In some implementations,the proximal end 118 of the bypass lumen 104 is connected to, coupled toor integrally formed near the proximal end 112 of the main body lumen102. The bypass lumen 104 and the one or more branch lumens 106 may havea distal end 120, 124, respectively, that are opposite the proximal ends118, 122, respectively. The distal ends 120, 124 have an opening thatallows the fluid or the blood to perfuse or exit into the one or moreblood vessels.

When the main body lumen 102 is positioned within the descending aorta,the one or more branch lumens 106 may be connected to one or moreextension grafts that are positioned within one or more branch vesselswhen deployed. FIG. 4 further describes the one or more extensiongrafts. The one or more branch lumens 106 may be in fluid communicationwith the main body lumen 102 and the bypass lumen 104. The one or morebranch lumens 106 may include any number of and/or any number of sets ofbranch lumens to branch into and perfuse blood through the one or moreextension grafts within the one or more branch vessels. The one or morebranch lumens 106 may include multiple branch lumens 106 including afirst set of branch lumens 108 a-b and a second set of branch lumens 110a-b. The first set of branch lumens 108 a-b may be longer in length thanthe second set of branch lumens 110 a-b and may extend farther distallyfrom the main body lumen 102 than the second set of branch lumens 110a-b.

When the main body lumen 102 is expanded and/or is deployed, the mainbody lumen 102 may support the vessel walls of the descending aorta 504,the first set of branch lumens 108 a-b may be connected to one or moreextension grafts that may be positioned within and support the vesselwalls of the one or more renal arteries 506, 508. The first set ofbranch lumens 108 a-b may be positioned near or in proximity to the oneor more renal arteries 506, 508. The second set of branch lumens 110 a-bmay be connected to one or more other extension grafts that may bepositioned within and support the vessel walls of the celiac artery 510and/or the SMA 512. The second set of branch lumens 110 a-b may bepositioned near or in proximity to the celiac artery 510 and/or the SMA512. This allows perfusion of blood through the descending aorta 504,the one or more renal arteries 506, 508, the celiac artery 510 and/orthe SMA 512.

The bypass lumen 104 may have a longitudinal length greater than 30 mm,but when the bypass lumen 104 is positioned within the main body lumen102 and offset from an opening in the main body lumen 102, the bypasslumen 104 may have a longitudinal length of approximately 30-79 mm. Thebypass lumen 104 may have a proximal end 118 that is positioned near orin proximity to the proximal end 112 of the main body lumen 102 butoffset a distance from the opening at the proximal end 112 of the mainbody lumen 102, as shown in FIGS. 2A-2B for example. In one embodiment,the length of the bypass lumen 104 may be shorter than the main bodylumen 102 by 10 mm or less, of which some example lengths are disclosedabove. Accordingly, if the main body lumen has a length of 45 to 75 mm,then the bypass lumen may be at least 35 mm and less than 75 mm. Inother embodiments, the bypass lumen 104 may be shorter by 5 mm or less.

FIGS. 2A-2B show the bypass lumen 104 re-located within the main bodylumen 102. Here, the bypass lumen 104 is positioned entirely within themain body lumen 102 but is offset a distance, such as a distance ofapproximately 1-3 mm distally or below an opening on the proximal end112 of the main body lumen 102. The bypass lumen 104 may extend distallywithin the main body lumen 102 to the distal end 114 of the main bodylumen 102 and the proximal ends 122 of the one or more branch lumens106, such that no shoulder or branch is formed at the juncture of thedistal end 120 of the bypass lumen 104 and an adjacent branch lumen ofthe one or more branch lumens 106. That is, the bypass lumen 104 may notextend outward from within the main body lumen 102 and ends orterminates at or near a point of separation between the one or morebranch lumens 106 and the bypass lumen 104. In some implementations, thebypass lumen 104 may not be offset from the opening of the main bodylumen 102.

The bypass lumen 104 may be connected to, coupled with or integrallyformed with an inner wall 202 of the main body lumen 102. That is, anouter wall 204 of the bypass lumen 104 and the inner wall 202 of themain body lumen 102 may share the same boundary and/or be the same wall.The shared boundary and/or the shared portion of the walls 202, 204 mayrun in a longitudinal direction from the proximal end 118 of the bypasslumen 104 to the distal end 120 of the bypass lumen 104. The outer wall204 may be fastened, coupled, or otherwise connected to the inner wall202 using a fastener 206, such as a stitching, as shown in FIG. 2B forexample. The fastener 206 may be positioned to connect a portion of theinner wall 202 and the outer wall 204 or may run along the entire lengthof the shared boundary between the inner wall 202 and the outer wall204. The fastener 206 may be a single stitch that runs along a sharedportion of the walls 202, 204, as shown in FIG. 3D for example, or maybe multiple stitches that run along the shared portion of the walls 202,204, as shown in FIG. 3E for example. In some implementations, the outerwall 204 of the bypass lumen 104 and the inner wall 202 of the main bodylumen 102 may be coupled without use of a fastener, connector or otherfastening means. For example, the outer wall 204 and the inner wall 202may be the same wall and/or integrally formed, as shown in FIG. 2A.

FIGS. 3A-3C also show the bypass lumen 104 disposed within the main bodylumen 102. When the stent graft 100 is deployed, the bypass lumen 104 isa single internal channel 302 within the main body lumen 102 thatextends distally or downward within the main body lumen 102 and that hasan outer wall 204 that is attached, connected, coupled, integrallyformed or otherwise interfaces or is shared with an inner wall 202 ofthe main body lumen 102. FIG. 3A shows the bypass lumen 104 offsetslightly from the opening near the proximal end 112 of the main bodylumen 102 to form the single internal channel 302. FIGS. 3B-3C showtop-down perspective views of the single internal channel 302 and thefirst set of branch lumens 108 a-b and the second set of branch lumens110 a-b. The diameter of the single internal channel 302 may beapproximately 12-16 mm. Moreover, each set of branch lumens 108 a-b, 110a-b of the one or more branch lumens 106 may have an opening ofapproximately 12-14 mm and each opening of the one or more branch lumens106 may be approximately 7-9 mm.

Since the bypass lumen 104 is positioned or re-located within the mainbody lumen 102 and does not extend outward distally from the main bodylumen 102, the bypass lumen 104 does not interfere with or obstruct theone or more branch lumens 106. Moreover, when the stent graft 100 isdeployed, since the bypass lumen 104 is re-located within the main bodylumen 102, the bypass lumen 104 does not obstruct the view of the one ormore branch lumens 106 and/or other lumens while viewed underfluoroscopy.

When the bypass lumen 104 is offset the distance from the opening of themain body lumen 102, a first extension graft 402 may be connected to theproximal end 112 of the main body lumen 102. When the bypass lumen 104is positioned within the main body lumen 102 and the bypass lumen 104does not extend outward from the main body lumen 102, the bypass lumen104 does not obstruct or otherwise interfere with the one or more branchlumens 106, which allows a second extension graft 406 to be connected tothe distal end 120 of the main body lumen 102.

FIG. 4 shows different extension grafts 402, 406 that may be connectedto the main body lumen 102 when the bypass lumen 104 is located entirelywithin the main body lumen 102 and positioned with an offset from theopening of the main body lumen 102. The first extension graft 402 mayhave a proximal end (not shown) and a distal end 404 that connects to orinserts into the proximal end 112 of the main body lumen 102. The firstextension graft 402 may be positioned above the stent graft 100, e.g.,in an upper portion of the descending aorta, and extend distally withinthe descending aorta and be connected to the proximal end 112 of themain body lumen 102, as shown in FIG. 4 for example. Moreover, when thebypass lumen 104 is within the main body lumen 102 and does not extendoutward from the main body lumen 102, a second extension graft 406 mayconnect to the bypass lumen 104 and/or the main body lumen 102. Thesecond extension graft 406 may have a proximal end 408 and a distal end410. The proximal end 408 of the second extension graft 406 may connectto and/or be inserted into the distal end 120 of the bypass lumen 104and/or the distal end 114 of the main body lumen 102.

The second extension graft 406 may be adjacent to the one or more branchlumens 106 and extend farther distally down the descending aorta thanthe one or more branch lumens 106 when deployed. The second extensiongraft 406 may be connected to the bypass lumen 104 after the otherextension grafts have been deployed (e.g., to the renal, celiac, and SMAarteries). The distal end 410 of the second extension graft 406 may beanchored or sealed in the aorta between the renal arteries and the iliacbifurcation, if there is a suitable non-aneurysmal landing zone. Ifthere is no suitable landing zone, bifurcated modular component may beconnected/inserted into the distal end 410 of the second extension graft406. This provides for a mechanism to gain seal in both iliac arteries.

Other extension grafts 412, 414, 416, 418 may connect to one or morebranch lumens 106. A third extension graft 412 and a fourth extensiongraft 414 may each be connected to one branch lumen of the first set ofbranch lumens 108 a-b. The third extension graft 412 and the fourthextension graft 414 each have a proximal end 420, 426, respectively, anda distal end 424, 428, respectively. The proximal ends 420, 426 mayconnect to and/or be inserted into the distal ends 124 of the first setof branch lumens 108 a-b and may be positioned within the one or morerenal arteries 506, 508. A fifth extension graft 416 and a sixthextension graft 418 may each be connected to one branch lumen of thesecond set of branch lumens 110 a-b. The fifth extension graft 416 andthe sixth extension graft 418 each have a proximal end 430, 434,respectively, and a distal end 432, 436, respectively. The proximal ends430, 434 may connect to and/or be inserted into the distal ends 124 ofthe second set of branch lumens 110 a-b and may be positioned within theceliac artery 510 or SMA 512.

While the extension grafts 412, 414, 416, and 418 are referred to hereinin the singular context, it is to be understood that two or moreextension grafts may be linked together to form an overall extensiongraft assembly. For example, since the distance to the renal arteriesmay be longer than to the celiac or SMA arteries, two or more extensiongrafts may be linked together such that a first extension graft iscoupled to the distal ends 124 of the branch lumens 108 a/b and a final(second, third, fourth, etc.) extension graft is coupled to the firstextension graft (possibly through intermediate grafts) and extends intoa renal artery. Similar extension graft assemblies may be used for theceliac and/or SMA arteries.

FIG. 5 shows a cross-sectional view of the stent graft 100 positionedwithin the descending aorta 504 to address an aortic aneurysm 502 andallow perfusion of blood. The main body lumen 102 may be positionedwithin the descending aorta 504, which is distal of the aortic arch, tosupport the inner surface of the vessel walls of the descending aorta504. The one or more branch lumens 106 may be configured to receiveextensions grafts that then extend within one or more branch vesselsincluding the one or more renal arteries 506, 508, the celiac artery 510and/or the superior mesenteric artery (SMA) 512. The first set of branchlumens 108 a-b may be longer in length than the second set of branchlumens 110 a-b in order to connect extension grafts that may be deployedinto one or more branch vessels that are farther distally from theaortic arch. For example, since the one or more renal arteries 506, 508are farther distally from the aortic arch, the longer of the first setof branch lumens 108 a-b and the second set of branch lumens 110 a-b,i.e., the first set of branch lumens 108 a-b, may be positioned closerto the one or more renal arteries 506, 508. Whereas, the other set ofbranch lumens, i.e., the second set of branch lumens 110 a-b, which areshorter in length than the first set of branch lumens 108 a-b, may bepositioned closer to the celiac artery 510 and/or SMA 512, which aremore proximal to the aortic arch than the one or more renal arteries506, 508. However, the relative lengths described above are not intendedto be limiting. In other embodiments, the lumens may all have the sameor similar length, or the relative lengths may be reversed (e.g., renallumens are shorter than celiac/SMA lumens).

Exemplary embodiments of the methods/systems have been disclosed in anillustrative style. Accordingly, the terminology employed throughoutshould be read in a non-limiting manner.

What is claimed is:
 1. A stent device for perfusion of one or morevessels, comprising: a tubular member having a single unitary bodyincluding a main body lumen, a bypass lumen and one or more branchlumens, the tubular member configured to be inserted into an aorta, themain body lumen being configured to expand and contact a vessel wall ofthe aorta, the bypass lumen being located completely within the mainbody lumen and each one or more branch lumens configured to couple toone or more extension grafts to perfuse one or more branch vessels; anda plurality of stent rings secured to the tubular member and configuredto be expandable to expand the tubular member to contact the vesselwalls; wherein: the main body lumen has a proximal end and a distal end,the bypass lumen has a proximal end and a distal end, the one or morebranch lumens have a proximal end and a distal end, and the distal endof the bypass lumen is aligned with the distal end of the main bodylumen and the proximal end of the one or more branch lumens.
 2. Thestent device of claim 1, wherein the main body lumen has an inner walland the bypass lumen has an outer wall, wherein the bypass lumen ispositioned within the main body lumen to form a single channel withinthe main body lumen, wherein the inner wall of the main body and theouter wall of the bypass lumen interface, connect or are integrallyformed and the bypass lumen does not extend beyond or outward from themain body lumen.
 3. The stent device of claim 2, wherein the bypasslumen is connected to the inner wall of the main body lumen to avoidobstruction of the one or more branch lumens, wherein the bypass lumenis connected at a position that offsets from a top of the main bodylumen.
 4. The stent device of claim 3, wherein an end of the bypasslumen terminates at or near a point of separation between the one ormore branch lumens and the bypass lumen.
 5. The stent device of claim 1,wherein a total coverage length, from a proximal aortic seal to a celiacartery, is less than 8 cm and the single unitary body allows the tubularmember to be arranged to minimize coverage of vessels.
 6. The stentdevice of claim 1, wherein the main body lumen, the bypass lumen and theone or more branch lumens are permanently connected to form the singleunitary body of the tubular member, which reduces an amount of coveragelength of the tubular member and a number of failure points incomparison to a modular tubular member.
 7. The stent device of claim 1,wherein the tubular member is made from a woven polyester and each ofthe plurality of stent rings is made from nitinol.
 8. A stent device forperfusion of one or more vessels, comprising: a tubular member having amain body lumen, a bypass lumen and one or more branch lumens, thetubular member configured to be inserted into an aorta, the main bodylumen being configured to expand and contact a vessel wall of the aortaand the bypass lumen being located and positioned within the main bodylumen at a position that is offset from a top of the main body lumen;and a plurality of stent rings secured to the tubular member andconfigured to expand the tubular member to contact the vessel walls;wherein: the bypass lumen has a proximal end and a distal end, the oneor more branch lumens have a proximal end and a distal end, and thedistal end of the bypass lumen is aligned with the proximal end of theone or more branch lumens.
 9. The stent device of claim 8, wherein theone or more vessels include the aorta, a celiac artery, superiormesenteric artery (SMA), a right renal artery and a left renal artery,wherein the tubular member is configured to allow perfusion through theone or more vessels.
 10. The stent device of claim 8, wherein the mainbody lumen has an inner wall and the bypass lumen is located proximallyto an inner wall of the main body lumen.
 11. The stent device of claim8, wherein the main body lumen, the bypass lumen and the one or morebranch lumens form a single unitary body.
 12. The stent device of claim11, wherein a total coverage length, from a proximal aortic seal to aceliac artery, is less than 8 cm.
 13. The stent device of claim 8,wherein the bypass lumen is connected to the inner wall of the main bodylumen to avoid obstruction with the one or more branch lumens.
 14. Thestent device of claim 8, wherein an end of the bypass lumen terminatesat or near a point of separation between the one or more branch lumensand the bypass lumen.
 15. The stent device of claim 8, wherein thetubular member is made from a woven polyester and each of the pluralityof stent rings is made from nitinol.
 16. A stent device, comprising: atubular member having a single unitary body including a main body lumen,a bypass lumen and one or more branch lumens, the tubular memberconfigured to be inserted into an aorta, the main body lumen beingconfigured to expand and contact a vessel wall of the aorta and thebypass lumen being located and positioned within the main body lumen ata position that is offset from a top of the main body lumen; and aplurality of stent rings secured to the tubular member and configured tobe expandable to expand the tubular member to contact the vessel walls;wherein: the main body lumen has a proximal end and a distal end, thebypass lumen has a proximal end and a distal end, and the distal end ofthe bypass lumen is aligned with the distal end of the main body lumen.17. The stent device of claim 16, wherein the tubular member isconfigured to allow perfusion through one or more vessels including theaorta, a celiac artery, superior mesenteric artery (SMA), a right renalartery and a left renal artery.
 18. The stent device of claim 16,wherein the main body lumen has an inner wall and the bypass lumen islocated proximally to an inner wall of the main body lumen, wherein theentire bypass lumen is located within the main body lumen.
 19. The stentdevice of claim 16, wherein: the one or more branch lumens have aproximal end and a distal end, and the distal end of the bypass lumen isaligned with the proximal end of the one or more branch lumens.